Efforts focused on teaching individuals with intellectual disabilities to manage their own affairs have evolved over the past 30 years. Self-management strategies, in particular, hold much promise when the goal is to promote self-determination. In this article, the authors describe trends in the evolution of self-management strategies by analyzing seven literature reviews. The authors conclude with thoughts related to jump-starting an intervention that has appeared to lose momentum, namely, self-management.
Over the last 30 years, numerous studies have been conducted in which individuals with intellectual disability have played a major role in managing their own affairs in work-related contexts versus being dependent on others. The overarching construct that describes the capacity to override other forces or determinants to act by making one's own conscious choices or having the power to make such choices has been identified as self-determination (Agran & Wehmeyer, 2008). A particular group of interventions devoted to enhancing self-determination have been collectively identified as self-management interventions, with the most commonly used self-management strategies being goal setting, self-instruction, self-monitoring, self-evaluation, and self-reinforcement (Rusch, 2011a).
In addition to more than 100 self-management studies published during this period (Rusch, 2011a), there are seven reviews related to self-management published since the mid-1980s (Browder & Shapiro, 1985). An outdated and costly approach in service delivery for individuals with intellectual disability was ending in the late 1970s and early 1980s, and another approach was beginning. This new approach is focused more on fostering the roles individuals with intellectual disability can play in identifying their own goals and in self-managing these goals versus relying on the altruistic beneficence of well-meaning service providers. This new strategy was, in part, a result of a major shift in where individuals with intellectual disability learned, worked, and resided.
Indeed, during this period, new research was surfacing, suggesting that externally mediated behavior-change strategies (e.g., token economies) that had predominated prior to the 1980s were obtrusive and offensive to others who were present, including family members, friends, coworkers, and fellow recreation participants in typical community settings. For example, Menchetti, Rusch, and Lamson (1981) surveyed food service industry supervisors and found that they would never allow job coaches to use a token economy or any of the components that comprise a token economy in their places of business. Thus, although token economies were widely used in diverse settings prior to the 1980s (Kazdin, 1982), Menchetti and colleagues discovered that (a) the only consequence of misbehavior (e.g., failing to follow directions, becoming obstinate, talking back to a supervisor) allowed for food service workers was a single verbal reprimand and being sent home for the day, a verbal reprimand and timeout from work, or a verbal reprimand and loss of reinforcement; (b) reprimands and dismissals were viewed as typical consequences; and (c) reprimands and alternative forms of punishment (timeout and response cost) were deemed unnatural and unacceptable.
The work of several social scientists facilitated this new trend in intervention approaches (e.g., Bandura, 1976; Kanfer, 1971; Karoly, 1977; Kazdin, 1984; O'Leary & Dubey, 1979; Shapiro, 1981), which ultimately helped to introduce and identify strategies that are currently being used, such as self-management, that rely more on people governing their own affairs rather than relying on paid personnel to govern them (Wolfensberger, 1976).
Our purpose in this review was to mine existing literature reviews conducted between 1980 and 2011 that were focused on self-management strategies to identify, in part, the evolution of self-management-related strategies applied to individuals with intellectual disability to help them control their own behavior, primarily in work-related ventures. We selected seven reviews of the self-management literature that appeared in refereed publications (Browder & Shapiro, 1985; Harchik, Sherman, & Sheldon, 1992; Hughes & Agran, 1993; Lancioni & O'Reilly, 2001; Martin & Hrydowy, 1989; Rusch, 2011b; Storey, 2007). Based on results of this meta-evaluation, we provide recommendations for future reviews and possible areas of study.
Brief Overview of Literature Reviews
Browder and Shapiro (1985)
The primary focus in this seminal review of self-management “technology” (Browder & Shapiro, 1985, p. 200) was to introduce self-management procedures to researchers and practitioners. Browder and Shapiro provided an insightful review of research associated with “behavioral consequences” (p. 200) and “antecedent procedures” (p. 203). The behavioral consequences concept, introduced by the authors, included self-monitoring, self-evaluation, and self-reinforcement, whereas antecedent procedures primarily consisted of self-instruction. These procedures introduced the framework for self-management studies that continues to this day.
Browder and Shapiro's (1985) review was not intended to include all self-management studies conducted prior to 1985. Consequently, they selected approximately two dozen studies primarily to help define emerging self-management technologies. Studies included participants with mild, moderate, or severe intellectual disability, and the research was conducted mostly in segregated classrooms and sheltered workshops, with a few applications in general education classrooms and competitive employment contexts.
Harchik, Sherman, and Sheldon (1992)
Harchik et al. (1992) sought to update Browder and Shapiro's (1985) review by including research conducted after 1985 and providing a more thorough review of each study in relation to antecedent- and consequent-focused procedures. For their analysis of 59 studies, they divided them into three categories (at completion of tasks or when behavior was exhibited, when prompted, and studies of self-instructing) similar to the two categories (behavioral consequences and antecedent procedures) used by Browder and Shapiro. The principal difference between the categories used by Harchik et al. and those of Browder and Shapiro was the recognition that Harchik et al. gave to studies that appeared to include an external agent (e.g., studies identified as “when prompted”) in the administration of reinforcement after a correct response. The majority of participants in these studies had mild or moderate levels of intellectual disability, although 13 studies included participants with severe intellectual disability. These studies included research conducted in a wide variety of segregated and inclusive settings. The major value of this review was the authors' focus on identifying who taught the strategies and whether the participant actually became a competent self-manager who did not require the long-term assistance of a trainer.
Hughes and Agran (1993)
Hughes and Agran (1993) analyzed five studies that met strict criteria for inclusion: (a) participants had to have worked in an integrated or community work setting, (b) they had to have moderate or severe intellectual disability, (c) the independent variable had to include some dimension of self-instruction as introduced by Meichenbaum and Goodman (1971), and (d) the study was published in a refereed journal.
The resulting studies included 5 participants with moderate intellectual disability and 10 with severe intellectual disability. The primary analytical approach used by Hughes and Agran was a descriptive analysis of effects of instructional strategies used to teach self-instruction and implementation strategies that promoted generalized skill acquisition. The importance of this study was that Hughes and Agran combined their collective experiences to discern whether the types of tasks used in the review might promote generalized learning. They hypothesized that if tasks varied across salient dimensions (e.g., their solutions), participants would more likely generalize their use of self-management to untrained, but similar tasks.
Lancioni and O'Reilly (2001)
Lancioni and O'Reilly (2001) reviewed 34 studies published between 1983 and 1999. Five instructional cues guided their analysis: (a) picture cues presented on sets of cards, (b) picture cues stored in computer-aided systems, (c) object cues attached to sets of cards, (d) verbal cues stored in audiorecording devices, and (e) self-verbalizations. The study was confusing because the authors did not include research in which participants utilized self-verbalizations if the focus was to “solve problem situations interfering with task performance.” This criteria was perplexing because it appeared to eliminate several recent and salient investigations from consideration (Hughes & Rusch, 1989; Martella, Agran, & Marchand-Martella, 1992). The literature review included only participants with severe or profound intellectual disability. The primary value of this review was the authors' focus on the importance of antecedent cue regulation.
Martin and Hrydowy (1989)
Martin and Hrydowy (1989) examined self-monitoring and self-reinforcement procedures reported in 17 articles that were focused on work productivity. The articles included a total of 107 participants with intellectual disability who worked in segregated work settings. The authors' purpose in the review was to identify effective procedures associated with increasing and maintaining the “work rate of developmentally disabled workers on tasks that have been learned, but are performed at a low rate” (p. 323). The importance of this review was that Martin and Hrydowy proposed an analytic model that is now being introduced as a salient component of conducting meta-analyses of single-participant research. Specifically, they introduced their results by referring to effect-size differences, which focuses on differencing pooled baseline and pooled intervention means to assess intervention effectiveness.
In this review, Rusch (2011b) sought to apply criteria recommended, in part, by Horner et al. (2005) for identifying evidence-based practices. Specifically, Rusch applied emergent criteria for assessing the methodological features associated with self-management to studies published in the Journal of Applied Behavior Analysis that were focused on work-related behavior. In selected articles, researchers examined self-management strategies utilized by employees with mild to severe intellectual disability. Settings were diverse, ranging from sheltered workshops, to training programs, and competitive employment. The studies met criteria identified by Horner and colleagues in the areas of investigator geographical and participant criteria to qualify as evidence-based. However, the studies were notable by their authors' almost collective failure to collect procedural fidelity data.
Storey (2007) reviewed articles published between 1979 and 2004 that included participants (a) with intellectual disability, (b) who were introduced to self-management procedures, and (c) who were in a supported employment setting, resulting in 14 articles. Storey's primary purpose was to identify self-management strategies introduced to participants working in competitive employment settings. He noted that there were procedural variations among investigators, and his major finding refocused readers to the influence of job coaches and on the steps that might be taken to direct attention back to how to promote participant autonomy—a point made by Harchik et al. (1992).
Analysis and Discussion
Our primary focus in this meta-evaluation was to identify and highlight trends associated with self-management and employment as reflected in published literature reviews conducted since the early 1980s (Browder & Shapiro, 1985). A second and equally important focus was to identify areas for future research. The review was not intended to evaluate the quality of existing literature reviews or to evaluate the quality of individual studies included in the seven reviews. Instead, our primary purpose was to collect and describe existing reviews on self-management and employment in hopes of sparking renewed interest in conducting related research.
Each of the selected literature reviews has made an important addition to understanding self-management strategies that include a family of strategies (i.e., antecedent cue regulation, self-monitoring, and self-reinforcement) that do not rely on someone other than, eventually, the person with intellectual disability to implement them. Results show that self-management has enjoyed considerable success in diverse settings. Originally introduced as a viable intervention approach by Browder and Shapiro (1985), over 100 studies and several summary reviews have been published to date (Rusch, 2011a).
Authors of more recent reviews voiced major concerns about several areas, recommending that they be investigated further. Harchik et al. (1992) and Storey (2007) noted the importance of future researchers considering the possibility of persons not typically associated with conducting studies (i.e., experimenters) introducing self-management. Lancioni and O'Reilly (2001) and Hughes and Agran (1993) focused on antecedent cue regulation and the saliency of tasks as important areas of future research. Martin and Hrydowy (1989) suggested the importance of evaluating intervention effect-size differences using quantitative methods. Finally, Rusch (2011b) recommended that procedural fidelity be reported by future investigators so as to minimize confusion about what actually comprises self-management.
There are several reasons why we highlight the importance of advancing self-management as a desired practice in integrated work settings. Foremost among them is the recognition that the development of opportunities for people with intellectual disability have expanded to include integrated contexts (Rusch & Braddock, 2005). However, job recidivism remains high among young adults with intellectual disability. In fact, unemployment among adults with intellectual disability may be higher today than at any point over the past 35 years (Rusch & Stodden, 2011). Reasons for high unemployment are not entirely clear; however, potential employees' ability to complete assigned tasks and to adjust to new demands at the work site have been suggested by numerous authors as important for job retention.
Literature reviews are important to the science of directing future research. The seven reviews considered here have made important contributions to suggesting the direction that self-management research should take in the future. For example, Martin and Hrydowy (1989) made an important contribution by analyzing work productivity. Specifically, in the analytic procedure used in their review, they focused on assessing effect-size changes resulting from different baseline and treatment means. Applying a parametric analytic framework to the available literature allowed these authors to discern a potential difference between good studies and better studies and led them to question intervention impact. Future researchers should include similar analyses so that systematic reviews of this literature can be facilitated.
Further, Martin and Hrydowy (1989) and Harchik et al. (1992) questioned the veracity of study findings in light of the fact that (a) research staff typically implemented the majority of self-management procedures over relatively short time periods, (b) researchers in the vast majority of the studies failed to report procedural reliability (Rusch, 2011a), and (c) research participants did not become independent or competent self-managers; that is, they did not become autonomous of the research staff.
Lancioni and O'Reilly (2001) extended our understanding of antecedent cues by introducing computer-aided systems with more traditional approaches to cuing participants. Traditional approaches included (a) picture cues of work tasks presented on cards, (b) picture cues of activity schedules presented on cards, (c) object cues (e.g., an actual glass of juice), (d) self-verbalizations, and (e) cues delivered by recording devices. The computer-aided systems reviewed by Lancioni and Oliva (1988) included (a) a standard computer and screen, (b) a wooden box with a plexiglass screen, (c) cuing and reinforcement slides, (d) a projector placed inside the wooden box that projected the image on a screen, and (e) control sensors located on a mat placed on the floor immediately beneath the wooden box and screen. Participants in a typical study conducted by Lancioni and colleagues viewed the required work task, completed the task, acquired the reinforcer for completing the task, and continued on to the next work task. Problems occurred when participants attempted to access the reinforcement because they became disoriented about where they were in the sequence of work activities. This resulted in displaying the entire sequence of activities on a shelf near the workstation.
Assessing Study Quality
Our purpose in this meta-evaluation was to locate and analyze literature reviews on the topic of self-management and their use among individuals with intellectual disability in employment contexts. Seven reviews have appeared in peer-reviewed journals over the past 30 years. Each of these reviews was timely when conducted and published, and additional areas of research are suggested as a result of these authors' insights.
One of the concerns expressed in most reviews was the considerable unevenness in the quality of the methods used by researchers to measure and analyze outcomes associated with self-management interventions. For example, Martin and Hrydowy (1989) mentioned that investigators of efficacy-based studies in their review did not fully report the procedures implemented to teach self-management. These authors also observed that investigators did not describe how they evaluated procedural fidelity.
In the future, it is important that literature reviews include an analysis of the quality of existing studies by assessing the investigators' attempts to lessen or ameliorate threats to internal and external validity, as recommended by Kratochwill and Stoiber (2002) and, more recently, by Rusch, Gast, and Datillo (2011).
Authors of each review included in this meta-evaluation made important and timely contributions that moved this area of research forward. Contributions included introducing self-management as a possible intervention to be used by persons with intellectual disability (Browder & Shapiro, 1985), introducing common rubrics to assess the effects of self-management (Martin & Hrydowy, 1989), studying the merits of using typical coworkers as trainers as opposed to job coaches (Harchik et al., 1992), narrowing the analysis to a subset of studies so that the importance of selected variables may be examined (Hughes & Agran, 1993), expanding antecedent cues to include new delivery approaches (Lancioni & O'Reilly, 2001), and focusing future literature searches to include single points of interest (e.g., only research conducted in competitive employment vs. work-experience programs and training programs set up to prepare future employees for possible employment).
There is merit in conducting additional research that extends our understanding of whether self-management is a viable strategy that promotes autonomy and eventually adaptability. Future research is needed to shed light on the shadows cast by investigators' failure to measure procedural fidelity and their almost exclusive use of research staff to implement procedures over relatively short periods of time. It is curious that only one research team explored the effects of self-management as a viable procedure to teaching competitively employed employees with intellectual disability, and these studies were conducted and reported several years ago (Browder & Minarovic, 2000; Minarovic & Bambara, 2007).
Editor-in-charge: Steven J. Taylor
This paper was funded in part by the National Institute for Disability Rehabilitation Research, U. S. Department of Education, Grant H133F100005.